与调强放疗和容积调强弧形放疗相比，螺旋断层放疗作为局部晚期食管癌的新辅助治疗可能会增加骨髓毒性。
Tomotherapy as a neoadjuvant treatment for locally advanced esophageal cancer might increase bone marrow toxicity in comparison with intensity-modulated radiotherapy and volumetric-modulated arc therapy.
作者信息
Wang Yulong, Xiao Qin, Zeng Biao, Ni Qianxi, Liu Xuewen, Liu Xiaoyang, Tian Lamei, Sheng Cai, Peng Lijuan, Wang Hui
机构信息
The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410008, China; Key Laboratory of Translational Radiation Oncology (2015TP1009), Changsha 410006, China.
The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410008, China; Key Laboratory of Translational Radiation Oncology (2015TP1009), Changsha 410006, China.
出版信息
Med Dosim. 2020;45(1):e6-e12. doi: 10.1016/j.meddos.2019.05.001. Epub 2019 Jun 5.
This study compares dosimetric parameters in these following 3 neoadjuvant chemoradiotherapy (NCRT) methods in treating locally advanced esophagus cancer: helical tomotherapy (TOMO), volumetric modulated arc therapy (VMAT), and intensity-modulated radiotherapy (IMRT). It is aimed to ascertain the efficient technique that kept high target coverage and availed the dose sparing of bone marrow (BM). This research collected data on 11 patients from October 2014 to June 2017 who received NCRT for pathologically confirmed esophageal cancer. The prescription doses to the planning target volume (PTV) were all given as 60 Gy (2 Gy per fraction, 5 days a week). Three physicists via Varian Eclipse Treatment Planning System and Accuray planning stations redesigned 5 radiotherapy plans (fixed 5-field IMRT, fixed 7-field IMRT, 2-arc VMAT, 3-arc VMAT, and TOMO) for each of the patients. At the end of the planning, we then appraised the dosimetric quality based on the PTV parameters and the doses to organs at risk (OARs). In the study VMAT reached the highest conformity index (CI; 2 arcs VMAT: 0.74 ± 0.10; 3 arcs VMAT: 0.78 ± 0.07; p< 0.05), and IMRT the lowest homogeneity index (HI; fivefields IMRT: 0.12 ± 0.03; sevenfields IMRT: 0.10 ± 0.02; p< 0.05). Besides, 7 fields IMRT (0.10 ± 0.02) achieved superior HI to that of 5 fields IMRT (0.12 ± 0.03, p< 0.01). TOMO (p< 0.05) and VMAT (p< 0.05) were both significantly superior to IMRT in terms of the dose to lung (V, V, V, V, and V). These 5 radiation techniques were similar regarding the dose to heart (V, V, and V), but IMRT (5 fields IMRT: 19.27 ± 5.33; 7 fields IMRT: 20.05 ± 4.19) significantly raised the dose to the V of the heart when compared to VMAT (2 arcs VMAT: 16.6 ± 5.68; 3 arcs VMAT: 15.04 ± 5.75; p< 0.05) and TOMO (15.05 ± 4.7, p< 0.05). VMAT reduced the dose to BM (V, V, V, and V) as compared to TOMO (p< 0.05) and IMRT (p< 0.05). The CI of VMAT was the supreme one in those of the techniques in this study, so was the HI of IMRT. VMAT also provided another advantage that it reduced the dose to the BM. TOMO ameliorated the dose sparing of the lung, but the dose that the BM absorbed from TOMO was of some concern about BM toxicity.
本研究比较了以下三种新辅助放化疗（NCRT）方法在治疗局部晚期食管癌时的剂量学参数：螺旋断层放疗（TOMO）、容积调强弧形放疗（VMAT）和调强放疗（IMRT）。旨在确定能保持高靶区覆盖率并有利于骨髓（BM）剂量 sparing的有效技术。本研究收集了2014年10月至2017年6月期间11例经病理确诊为食管癌并接受NCRT的患者的数据。计划靶区（PTV）的处方剂量均为60 Gy（每次分割2 Gy，每周5天）。三名物理师通过瓦里安Eclipse治疗计划系统和Accuray计划工作站为每位患者重新设计了5种放疗计划（固定5野IMRT、固定7野IMRT、2弧VMAT、3弧VMAT和TOMO）。在计划结束时，我们根据PTV参数和危及器官（OARs）的剂量评估剂量学质量。在研究中，VMAT达到了最高的适形指数（CI；2弧VMAT：0.74±0.10；3弧VMAT：0.78±0.07；p<0.05），而IMRT的均匀性指数（HI）最低（5野IMRT：0.12±0.03；7野IMRT：0.10±0.02；p<0.05）。此外，7野IMRT（0.10±0.02）的HI优于5野IMRT（0.12±0.03，p<0.01）。在肺剂量（V、V、V、V和V）方面，TOMO（p<0.05）和VMAT（p<0.05）均显著优于IMRT。这5种放疗技术在心脏剂量（V、V和V）方面相似，但与VMAT（2弧VMAT：16.6±5.68；3弧VMAT：15.04±5.75；p<0.05）和TOMO（15.05±4.7，p<0.05）相比，IMRT（5野IMRT：19.27±5.33；7野IMRT：20.05±4.19）显著提高了心脏V的剂量。与TOMO（p<0.05）和IMRT（p<0.05）相比，VMAT降低了BM的剂量（V、V、V和V）。VMAT的CI在本研究的技术中是最高的，IMRT的HI也是如此。VMAT还具有另一个优势，即它降低了对BM的剂量。TOMO改善了肺的剂量 sparing，但BM从TOMO吸收的剂量对BM毒性存在一些担忧。
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